Medical Claims Examiner - Hybrid/Remote - Fresno, CA

ZipRecruiter; Fresno (CA); Remote; USD 60,000 - 80,000; Full time

Job summary

A well-respected insurance company in California seeks a Medical Claims Examiner for a primarily remote position. This role involves reviewing health insurance claims, ensuring data accuracy, and resolving coverage questions. Candidates with 1-2+ years of relevant experience and a high school diploma are encouraged to apply.

Qualifications

• 1-2+ years reviewing and processing health insurance claims.
• Proficient with data entry and various software systems.
• Comprehensive knowledge of employee benefits.

Responsibilities

• Compares data on claim applications with policy files.
• Corresponds with agents and claimants regarding claims.
• Examines claims to determine coverage and liability.

Skills

Data entry

Medical claims processing

Customer service

Communication

Education

High school diploma

College degree

Tools

Microsoft Office

Outlook

Job description

Job DescriptionJob Description

Medical Claims Examiner - Remote - Fresno, CA

*100% Remote for Central Valley candidates*

Candidates are required to attend occasional trainings/meetings in Fresno, CA

The Company:

A well-respected insurance company in California with over 25 years in the business is looking to add a Medical Claims Examiner! This company is dedicated to helping clients, providing excellent customer service, and truly investing in their employees.

What’s in it for you?

• $19.00 - $22.00/hour depending on experience

• Primarily remote position with occasional trainings/meetings in the office.

What we need from you:

• Experience - 1-2+ years reviewing and processing health insurance claims

• Education - High school diploma required, college degree

• Software - You are proficient with data entry, Microsoft Office, Outlook, carrier websites, and other software systems as needed for the position

• Comprehensive knowledge - You have data entry coding and medical claims processing experience

What you will be doing:

• Comprehensive understanding of employee benefits for medical, dental, and vision plans.

• Compares data on claim application with policy file and other company records to ascertain completeness and validity of claim

• Refers most questionable claims to investigator or to claim adjuster for investigation and settlement

• Corresponds with agents and claimants to correct errors or omissions on claim forms and to investigate questionable entries

• Examines claim adjusters' reports or similar claims/precedents to determine the extent of coverage and liability

• Contacts doctors, lawyers, or others involved to resolve claim/coverage questions

• Perform other duties and responsibilities as assigned by management

APPLY NOW!

Company DescriptionWhy Insurance Relief?

As a businessperson in the insurance industry, it is an advantage to partner with a staffing expert and ally who understands your unique skills and needs. With vast experience in the insurance arena, Insurance ReliefTM works with brokers, carriers, and third party administrators to locate and place the best people for positions ranging from entry-level to senior management. We invest the time to truly understand what you want to accomplish and then do our best to find meaningful opportunities.Company DescriptionWhy Insurance Relief?

As a businessperson in the insurance industry, it is an advantage to partner with a staffing expert and ally who understands your unique skills and needs. With vast experience in the insurance arena, Insurance ReliefTM works with brokers, carriers, and third party administrators to locate and place the best people for positions ranging from entry-level to senior management. We invest the time to truly understand what you want to accomplish and then do our best to find meaningful opportunities.